Provider Demographics
NPI:1780678102
Name:GERIG, KEVIN D (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:GERIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2006 S MAIN ST
Mailing Address - Street 2:STUITE A
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-5232
Mailing Address - Country:US
Mailing Address - Phone:574-535-9100
Mailing Address - Fax:574-535-1020
Practice Address - Street 1:2006 S MAIN ST
Practice Address - Street 2:STUITE A
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5232
Practice Address - Country:US
Practice Address - Phone:574-535-9100
Practice Address - Fax:574-535-1020
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01039933A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100354590Medicaid
F24681Medicare UPIN
164560DMedicare ID - Type Unspecified